October 5, 2018

The New Jersey Department of Banking and Insurance, Division of Insurance, Consumer Protection Services, Office of Managed Care, issued its semi-annual report to the Legislature on activities related to the Independent Health Care Appeals Program from January 1, 2018 through June 30, 2018. To view the report, visit: https://www.nj.gov/dobi/division_insurance/managedcare/omc/40thihcaprpt.pdf

October 4, 2018

On September 11, 2018, the Insurance Division issued Bulletin B 18-13. The bulletin stated that the Alaska Division of Insurance will resume oversight of the external review process on October 1, 2018. To view this bulletin, visit: https://www.commerce.alaska.gov/web/Portals/11/Pub/INS_Bulletin.B18-13.pdf

September 28, 2018

The Colorado Department of Regulatory Agencies, Division of Insurance, adopted new Rule 4-7-03: Standards for Health Maintenance Organizations, effective June 1, 2018. The purpose of the regulation is to establish standards to ensure that each HMO licensed in Colorado delivers quality health care services and to ensure that each HMO seeking licensure in Colorado has […]

September 25, 2018

On August 23, 2018, the California Supreme Court ruled in favor of a utilization review (UR) physician accused of malpractice. Specifically, the Court unanimously held that a claim for malpractice against a UR physician for injuries arising from a review decision for the treatment of a compensable injury could not be maintained under the workers’ […]

August 15, 2018

Per the Connecticut Department of Insurance examination report dated July 24, 2018, it was noted that OptumHealth Care Solutions (OHCS) failed to follow the procedure of including a reference to a weblink to access the clinical criteria online. In order to remedy this deficiency, OHCS updated the template language to include this reference. To  view […]

March 15, 2018

Pursuant to Alaska Register 225, changes to 3 AAC 28.900 – 3 AAC 28.918 (Utilization Review and Benefit Determinations), 3 AAC 28.930 – 3 AAC 28.938 (Health Care Insurer Grievance Procedure), 3 AAC 28.950 – 3 AAC 28.982 (External Review of Health Care Coverage Decisions), and 3 AAC 28.989 (General Provisions: Utilization and Benefit Determination, […]